In reply to Connie's posting about frenulums, we too have this issue at our
hospital. Fortunately our two main pediatric groups do frenotomy's in the
hospital. We have also been asked to "not diagnose" by some of the other
pediatricians but we asked if we also were not to "diagnose" sore, cracked nipples." I
feel we are lucky to have our two main groups who do support frenulotomies . We
approach the topic by explaining to the parents what a frenulum is and
pointing out the placement. Most parents inform us that one of them had it too and
did have it "clipped." When we have a parent who has one of the other groups,
we explain there are two schools of thought about clipping vs. not clipping and
it usually is how their doctor was trained. We sometimes see damage within
the 2 - 3 day hospital stay and have tried nipple shields when the pediatrician
does not clip. They" feel" the frenulum will stretch in time" ( but maybe not
before mom gives up breastfeeding!).We sometimes explain there are options
such as seeing a pediatric dentist or orals surgeon for a second opinion. We
usually find anywhere from 1 to 4 tight frenulums a week routinely. I feel this is
due to our assessment of mom and baby including a visual exam and a suck
assessment on most of our babies. Not all tight frenulums need to be clipped. If
mom can get a deep latch, nipples do not become terribly sore and baby's weigh
is good then clipping is probably not needed. It seems to relate to how tight
and thick the frenulum really is. I understand how this can be difficult to
deal with the pediatricians who do not support clipping. There was a posting
some time ago from a dentist with slides and I have given copies to some of the
pediatricians. It does feel like we sometimes are walking in a tight rope in
our positions.
Mary Shay RN BSN IBCLC
Dayton, Ohio

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